On-Demand Suction to Maintain a Dry Operative Field During Robotic Esophagectomy With Video

Lymphadenectomy around the left recurrent laryngeal nerve is one of the most technically demanding steps in esophagectomy. Even in robot-assisted esophagectomy, the operative field easily becomes wet and achieving on-demand suction remains challenging.

Between July 2024 and November 2025, 11 patients underwent robot-assisted esophagectomy in the prone position. We developed a simple on-demand suction technique by suturing gauze to a commercially available suction tube, allowing both the surgeon and the assistant to perform suction as needed. The modified tube can be manipulated using either robotic instruments or assistant forceps and can also be used for gentle tracheal rolling during lymphadenectomy. Furthermore, to evaluate the feasibility and safety of this technique, we conducted a retrospective comparison with 11 cases performed using the conventional method (tracheal traction with a robotic Cadiere forceps) between March 2023 and May 2024. All procedures were performed by a single surgeon.

This simple and low-cost technique facilitates maintenance of a dry operative field during robot-assisted esophagectomy. Furthermore, in comparison with the conventional method, no significant differences were observed in operative time, blood loss, or the incidence of recurrent laryngeal nerve palsy; however, there was a trend toward reduced intraoperative manipulation time. These findings suggest that this technique offers comparable safety to the conventional approach while potentially contributing to improved operative field management.